Zavadzki Giovanna, Reyes Barros Tomás, Sarfatis Feige Alberto, Granada Castaño Jaime, Kobus Garin Valentina, Ramos-Rojas José, Bigossi Aguiar Natália, Inzunza Robles José
Fundación Epistemonikos, Universidad Federal de Sao Paulo, Brasil.
Departamento de Enfermedades Infecciosas del Adulto, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2023 Jul;151(7):941-946. doi: 10.4067/s0034-98872023000700941.
Lawsonella clevelandensis is a gram-positive anaerobic bacillus, partially acid-fast, belonging to the order Corynebacteriales and is considered commensal of the skin and oral cavity. In recent years, few cases of infection by this microorganism have been reported, generally in immunosuppressed patients, with the most reported clinical presentation being the generation of abscesses. The isolation of this bacterium is difficult since it does not grow in traditional cultures, so its identification usually requires the use of molecular biology. We present the case of a 29-year-old patient with a kidney transplant and progressive worsening of kidney function in the context of a pauci-immune vasculitis which required greater immunosuppression. During the investigation, it was identified an asymptomatic leukocyturia, with a negative urine culture, for which six urine smear microscopy tests were performed of which 3 were positive, but with a negative Koch culture. Sequencing of the gene that codes for the 16s RNA of the bacterial ribosome was performed from a urine sample, obtaining a sequence compatible with Lawsonella clevelandensis. After the result, therapy with amoxicillin-clavulanic acid was indicated with resolution of the leukocyturia and negative smear microscopy, and immunosuppression could be indicated without inconvenience. To the authors' knowledge, this is the twelfth case of Lawsonella clevelandensis infection described in the medical literature in the world and the first to report the isolation of the pathogen in urine.
克利夫兰劳森菌是一种革兰氏阳性厌氧杆菌，部分抗酸，属于棒杆菌目，被认为是皮肤和口腔的共生菌。近年来，关于这种微生物感染的病例报道较少，通常发生在免疫抑制患者中，最常见的临床表现是脓肿形成。由于这种细菌在传统培养中不生长，因此其分离困难，所以其鉴定通常需要使用分子生物学方法。我们报告一例29岁肾移植患者，在少免疫性血管炎背景下肾功能进行性恶化，需要更强的免疫抑制治疗。在检查过程中，发现无症状白细胞尿，尿培养阴性，为此进行了6次尿涂片显微镜检查，其中3次阳性，但科赫培养阴性。从一份尿液样本中对编码细菌核糖体16s RNA的基因进行测序，获得了与克利夫兰劳森菌相符的序列。结果出来后，给予阿莫西林-克拉维酸治疗，白细胞尿消失，涂片显微镜检查阴性，且可以安全地进行免疫抑制治疗。据作者所知，这是世界医学文献中描述的第12例克利夫兰劳森菌感染病例，也是首例报道在尿液中分离出该病原体的病例。
